Provider Demographics
NPI:1063859585
Name:KELLERMAN-COLLINS, MAUREEN D (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:D
Last Name:KELLERMAN-COLLINS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 SHIRLEY RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN DALE
Mailing Address - State:NY
Mailing Address - Zip Code:12763-5229
Mailing Address - Country:US
Mailing Address - Phone:914-512-0325
Mailing Address - Fax:
Practice Address - Street 1:162 E BROADWAY
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-8815
Practice Address - Country:US
Practice Address - Phone:845-796-1350
Practice Address - Fax:845-791-8073
Is Sole Proprietor?:No
Enumeration Date:2013-05-23
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008779235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist